检验医学与临床2025，Vol.22Issue(15)：2026-2032,7.DOI:10.3969/j.issn.1672-9455.2025.15.003
耐药肺炎克雷伯菌感染脓毒症患者血清NLRP3、PCT、CCL25水平及与预后的关系
Serum levels of NLRP3,PCT and CCL25 in patients with sepsis caused by drug-resistant Klebsiella pneumoniae infection and their relationship with prognosis
摘要
Abstract
Objective To investigate the serum levels of nucleotide-binding oligomerization domain-like re-ceptor protein 3(NLRP3),procalcitonin(PCT),chemokine ligand 25(CCL25)in patients with sepsis caused by drug-resistant Klebsiella pneumoniae(KP)infection and their relationship with prognosis.Methods A to-tal of 205 patients with sepsis caused by KP infection admitted to the Affiliated People's Hospital of Chongqing Three Gorges Medical College from March 2019 to March 2024 were selected as the study group.According to whether they were drug-resistant or not,98 patients with sepsis caused by drug-resistant KP in-fection were classified as the drug-resistant group,and 107 patients with sepsis caused by non-drug-resistant KP infection were classified as the non-drug-resistant group.According to the severity of sepsis,205 patients with sepsis caused by KP infection were divided into the severe sepsis group(89 cases)and the sepsis group(116 cases).Another 205 healthy volunteers who underwent physical examinations at the Affiliated People's Hospital of Chongqing Three Gorges Medical College during the same period were selected as the control group.The drug resistance of drug-resistant KP to clinical drugs was determined.According to the survival status of patients with sepsis caused by drug-resistant KP infection 28 d after admission,they were divided in-to the survival group and the death group.The level of serum NLRP3 was detected by enzyme-linked immu-nosorbent assay,and the levels of PCT and CCL25 were determined by chemiluminescence.The diagnostic val-ue of serum NLRP3,PCT and CCL25 for sepsis caused by drug-resistant KP infection and their predictive val-ue for death in patients with sepsis caused by drug-resistant KP infection were analyzed by using the receiver operating characteristic(ROC)curve.Multivariate Logistic regression was used to analyze the influencing fac-tors of death in patients with sepsis caused by drug-resistant KP infection.Results A total of 125 drug-resist-ant KP strains were detected in 98 patients with sepsis caused by drug-resistant KP infection,and their resist-ance rates to cefazoline,ceftriaxone,ceftazidime,amtronem,imipenem and meropenem were>90%.The levels of serum NLRP3,PCT and CCL25 in the severe sepsis group were higher than those in the control group and the sepsis group,and the levels in the sepsis group were higher than those in the control group,and the differ-ences were statistically significant(P<0.05).The levels of serum NLRP3,PCT and CCL25 in the drug-re-sistant group were higher than those in the non-drug-resistant group,and the differences were statistically sig-nificant(P<0.05).The serum albumin(ALB)level in the death group was lower than that in the survival group,while the serum NLRP3,PCT,CCL25 levels,Acute Physiology and Chronic Health Evaluation Ⅱ(A-PACHEⅡ)score and infection-related Organ Failure Assessment(SOFA)score were higher than those in the survival group,and the differences were statistically significant(P<0.05).The results of multivariate Lo-gistic regression analysis showed that elevated levels of serum NLRP3,PCT and CCL25 were risk factors for death in patients with sepsis caused by drug-resistant KP infection(P<0.05),and elevated levels of serum ALB were protective factors for death in patients with sepsis caused by drug-resistant KP infection(P<0.05).The results of ROC curve analysis showed that the area under the curve(AUC)of serum NLRP3,PCT,CCL25 and the combined diagnosis of sepsis caused by drug-resistant KP infection by the 3 indicators was larger than that of NLRP3,PCT and CCL25 diagnosed alone(P<0.05).The AUC of the combined pre-diction of death in patients with sepsis caused by drug-resistant KP by the 3 indicators was greater than that predicted by NLRP3,PCT and CCL25 alone(P<0.05).Conclusion The levels of serum NLRP3,PCT and CCL25 in patients with sepsis caused by drug-resistant KP infection are relatively high.The combined detec-tion of the 3 indicators has a high diagnostic value for sepsis caused by drug-resistant KP infection and is relat-ed to the death of patients.关键词
脓毒症/耐药/肺炎克雷伯菌/核苷酸结合寡聚化结构域样受体蛋白3/降钙素原/趋化因子配体25/诊断/预后Key words
sepsis/drug resistance/Klebsiella pneumoniae/nucleotide-binding oligomerization do-main-like receptor protein 3/procalcitonin/chemokine ligand 25/diagnosis/prognosis分类
医药卫生引用本文复制引用
谭晓梅,谭茂华,谭雪梅,熊琴,高丽萍..耐药肺炎克雷伯菌感染脓毒症患者血清NLRP3、PCT、CCL25水平及与预后的关系[J].检验医学与临床,2025,22(15):2026-2032,7.基金项目
重庆市2021年科卫联合中医药技术创新与应用发展项目(2021ZY023924). （2021ZY023924）
